Many people are both upset and frightened when their spine surgeon recommends a fusion as a solution to their neck problems. An anterior cervical discectomy and fusion (ACDF), in the properly selected patient, has a very high success rate, with very satisfied patients.
In our practice, patients who elect to have cervical fusion typically have these following criteria:
1. Usually, the patients have neck pain with arm radiculopathies (pain, numbness or tingling down the arms and into the hands). Often just on one side in the case of a disc herniation.
2. Diagnostic studies usually reveal one or more cervical disk herniations, cervical bones spurs (spinal stenosis), or evidence of instability of the cervical spine. Those are the most common indications for cervical fusions. Less often, but still common, the studies can reveal a fracture, infection or tumor. In that scenario, often surgery needs to be performed on an urgent basis. If you have any of the last three problems, you should have evaluation immediately, so as to avoid a potential permanent problem.
3. If you have progressive weakness, or increasing pain despite non-surgical care, then you are a candidate. In some instances, the location of the disk herniation or bone spur may be accessible by a posterior neck decompression surgery called a foraminotomy. In this situation, you can remove the cause of the neck pain and arm pain without fusion. Your surgeon will be able to discuss why you would or would not be a candidate for this lesser surgical option. In general, if the location of the disk herniation or bone spur is more towards the midline of the spine, it can be risky to move the spinal cord to remove the spur with the lesser foraminotomy procedure.
4. One and two level cervical fusions have a better predicted outcome than three or more levels. If you need more than two levels, please discuss the rationale for the multiple levels. In my practice, we try to avoid more than two levels, but, in certain instances such as multiple levels of disk herniations or spurs, you cannot avoid the additional levels of surgery.
5. Patients are counseled not to smoke. Any type of fusion surgery has a higher success rate in patients who do not smoke. Smoking is associated with higher rates of non-union, or failure of the bones to successfully unit.
Cervical fusions are very successful in the properly selected patient, and have a much higher satisfaction and outcome than lower back fusion surgery. Please do not assume neck fusion surgery and lower back fusion surgery have the same results. If you have significant neck pain, with corresponding nerve compression pain limited to one or two levels, cervical fusion can be a good treatment option for you.
- Gutman G, Rosenzweig DH, Golan JD. The Surgical Treatment of Cervical Radiculopathy: Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976). 2017 Jul 11; PubMed PMID: 28700452
- Wu TK, Wang BY, Meng Y, Ding C, Yang Y, Lou JG, Liu H. Multilevel cervical disc replacement versus multilevel anterior discectomy and fusion: A meta-analysis. Medicine (Baltimore). 2017 Apr;96(16):e6503. PubMed PMID: 28422837